Editor’s Note: This story is one in a series of three about the foster care crisis in Ohio.
“It’s sad to me that we’re accepting this as the new normal, that it’s fine for kids to have to sit in a government agency until we find some placement whether appropriate or not for this kid.”
Ohio is among nine states where child-welfare services are administered by counties and overseen by the state. Advocates say a statewide solution is needed and have asked lawmakers to create a task force to come up with recommendations and aggressively implement them.
The Public Children Services Association of Ohio’s Sausser said that, most immediately, crisis beds are needed to house youth until placements are available. The larger problem is a nationwide shortage of in-home and community-based treatment interventions for youth with developmental delays and mental health challenges.
Gov. Mike DeWine has championed many initiatives for children, including those in foster care. Most recently, the administration announced a campaign to expand the number of adoptive parents, foster families and kinship caretakers.
Bill Teets, communications director for the Ohio Department of Job and Family Services, said the administration is committed to working with the children services association and others to address the foster care placement issue. “It is important that youth have access to the most appropriate services and supports, which includes placements that meet their needs,” he said.
Creation of the state’s new Department of Children and Youth, Teets said, will provide stakeholders additional opportunity to provide input on children’s issues, including foster care placement. The new department is established in Ohio’s biennial budget, which took effect in July.
The children services association first sounded the alarm in 2016, and in a report released last year, found “the challenge of securing timely and appropriate placements continues to grow, particularly for youth coming into care with significant behavioral health needs, developmental/intellectual disabilities, or as a diversion from juvenile corrections.”
“We released our report in February 2022 and to date nothing has really been done,” Sausser said. “It’s sad to me that we’re accepting this as the new normal, that it’s fine for kids to have to sit in a government agency until we find some placement whether appropriate or not for this kid. We are grateful that the Governor’s Office plans to explore solutions with us because experience in other states proves that statewide, cross-departmental leadership is needed to get results.”
The crisis is not just impacting Ohio. In 2021, in the wake of the COVID outbreak, the American Academy of Pediatrics issued a national state of emergency in children’s mental health, and the U.S. Surgeon General released an advisory on protecting youth mental health.
Health care providers are advocating preventative care and early intervention by having mental health therapists in pediatric primary care practices. The idea is to identify and treat problems earlier so kids avoid bigger issues later.
Illustrating the need, Cincinnati Children’s provided some sobering statistics:
14% of Ohio youth had a severe major depressive episode in 2022
More than half did not receive any mental health treatment
Three-fourths of Ohio’s 88 counties have a shortage of mental health professionals
A reactive health-care system isn’t working for these kids, said Cincinnati’s Junger. Early intervention is needed. Approaching a child’s brain health like their physical health could pay dividends down the road by preventing conditions from worsening and reducing the number of youth entering the child welfare system.
The hospital opened a clinic providing primary care for youth in state custody which has pediatricians, mental health professionals and social workers side-by-side caring for kids.
“If we can put those behavioral health providers right in the pediatrician’s oﬃce where [patients and their families] have these decades-long relationships with their primary care providers, we can do what as a society we need to be doing and making sure we are caring for each and every child.”
Sausser added that enforcing the state Medicaid program’s responsibility for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) and ensuring that mental health challenges are treated the same as physical health challenges is also needed.
Nearly every state is dealing with foster placement issues, including Virginia and Colorado, which like Ohio have county-administered systems.
If Ohio creates a task force, it would be following in the steps of Virginia, which last year dramatically reduced the number of foster youth sleeping in child welfare oﬃces.
“There is both a short-term and a long-term solution to it,” said Janet Kelly, who as special advisor to Gov. Glenn Youngkin led Virginia’s Safe and Sound Task Force.
Long term, Kelly said, states must bolster infrastructure by supporting and expanding kinship and family-based foster care placements. This allows kids to get treatment while staying in a family-like environment where they tend to do best.
Short-term, Virginia shifted staﬀ to intensify and individualize the search for placements, negotiating case by case with providers.
“The governor made it a priority. We put together a multi-disciplinary team with our Medicaid agency, our behavioral health agency, our social services agency, and we basically staﬀed every single kid who was in an oﬃce or who was in danger of being in an oﬃce,” Kelly said.
If a provider declined a placement, “we would call them back and say ‘Okay, how do we get to yes?’” Whatever was needed – more money, specialists, additional services – they found a way to provide it.
“We could say, ‘Does he need one-on-one care? Great, we’ll pay for that. Does he need a special training or special attention? For example, sexual violence? Okay, we’ve got an expert for that.’ We would just take a highly individualized approach for these kids.”
But the results were not lasting, Kelly acknowledged.
“We went all in for about 90 days,” she said. “We took all of our best people out of our agencies and put them on this project, and we were able to reduce the number of kids living in oﬃces by 89% in 90 days. That’s not a sustainable solution. Those people have jobs, and once they went back to their jobs our numbers started to go up.”
Still, oﬃcials learned it could be done and are finding ways to adapt. They also reduced the average length of time a child stays in an agency oﬃce, emergency room or hotel to three days, down from seven.
In Colorado, oﬃcials are trying to expand available beds at existing treatment facilities and building a new state-run center for high-need kids. They earmarked $23 million to boost provider payments, combat staﬀ shortages and expand specialized care, and contracted with two private facilities for 27 beds, quickly filling them all.
In April, about 82 Colorado kids had to stay in child-welfare oﬃces, hospitals, hotels, detention centers or out-of-state facilities because treatment was not available.
“We have so much left to do,” said Minna Castillo Cohen, director of the Oﬃce of Children, Youth and Families at the Colorado Department of Human Services.
“We are really trying to do this in a lot of diﬀerent ways: building out workforce, trying to work to increase capacity, looking at the incentives that can be oﬀered to providers who are willing to accept these young people in and building additional capacity across the board by looking at data.”
The spike in demand for more intensive services followed closure of several residential treatment facilities, pushing more kids into foster homes and kinship care. Like Virginia, Colorado oﬃcials started by creating a task force to come up with a plan.
“This is not solved by one, two or three strategies, certainly not in the immediate short-term. This is long-term work, and you have to approach it from diﬀerent angles,” said Heather Durosko, with the Colorado Human Services Directors Association.
In Columbus, Zoey doesn’t have a solution. She just doesn’t want to spend another night in the child welfare oﬃce.
“The couch was hard, the shower was broken. We just sat here,” she said. “Yeah, I really don’t want to come back here.”
Catherine Candisky is a freelance journalist who retired from The Columbus Dispatch in 2020 after a 35-year career as a reporter covering state government and politics with a focus on education, health and human services. This article was produced under a contract with the Public Children Services Association of Ohio. This story printed with permission from Public Children Services Association.